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PT Over Pain Pills

Physical therapy is an effective, drug-free treatment that can reduce pain. Kris Fontaine, physical therapist, discusses physical therapy.
PT Over Pain Pills
Kris Fontaine, PT
Kris Fontaine, PT graduated from Quinnipiac College. She has more than 27 years of outpatient experience with emphasis on an orthopedic caseload. She has a special interest in and has been a clinical specialist in fall prevention, and has given educational talks in the community. She also has gone to conferences on strength and conditioning, enjoys working with athletes, and has previously developed a protocol for education and treatment of patients with osteoporosis. She loves being involved in educating people on various aspects of their condition, exercise, posture, and body mechanics.

Prakash Chandran (Host):  For many people who suffer from chronic pain, their go-to treatment is pain medication because let’s face it, it feels like the fastest way to get relief. But did you know that physical therapy can actually provide a safer and healthier alternative to pills? We’re going to talk about it today with Kristine Fontaine, a Physical Therapist at Harrington Hospital. This is Healthy Takeout, the podcast from Harrington Hospital. I’m Prakash Chandran. So, first of all, Kristine, it’s good to have you here today. I’m curious as to why Physical Therapy is so important and why it should be considered before people jump to pain medications for relief.

Kris Fontaine, PT (Guest):  I first want to say thank you for having me and I do really welcome the opportunity to be an advocate for my profession. So, the really simple answer is that physical therapy is drug free, nonaddictive treatment for many types of pain that can be extremely effective. I do have to say, when we talk about and think about pain, I have to acknowledge that there are different kinds of pain. You have that acute pain, that might be from an injury or an accident or trauma or surgery where your pain level is really high in the beginning which is expected but it is expected to also decrease over time and I find that in those instances, narcotics definitely has its place. Then there’s the kind of pain that you and I and most of us have which might be from an overuse injury, or a sprain or a strain or a pulled muscle. Pain from those issues quite frequently is what causes a person to seek medical attention from their primary doctors. but the tough thing is when the patients go to the primary doctors and I’ve been doing this for a long time; the very first thing that they do for most patients is to write out a prescription. And this is where I would really like to see physical therapy chosen as that initial intervention for people but unfortunately, it really doesn’t happen that often.

Host:  Yeah and just as a lay person here, it really feels like when you take pain medication, even though it gives you that instant potential relief, it’s not really getting to the root cause of why you are suffering and that’s what physical therapy really gets at. Wouldn’t you say?

Kris:  Yes. For sure. So, pain does occur for a reason which we can’t ignore which is kind of what a pill does is it kind of makes it go away and forget that you have it. But pain occurs for a reason. When people come into physical therapy, we are trained specifically and are known as musculoskeletal specialists. So, this is our thing. We’re the ones when somebody comes in, we look at their posture. We look at their movement. We spend a great deal of time talking to somebody about what caused their pain, what their job might be, how long have they had it. and it’s funny because somebody might come in with a diagnosis of neck pain and the pain might be coming directly from a tight muscle or a stiff joint and we treat that and hopefully make them feel better. But we also delve deeper to try and figure out why did that pain come on. Like maybe they have a desk job and their posture is horrible or they are a kid and they carry backpacks all day. And nowadays with kids gaming and everybody on their phones, postural issues are becoming more and more a part of people’s onset of pain and symptoms.

Host:  So Kristine, I’m curious as to if there is any science or any sort of research being done around physical therapy and pain management that you can share with us.

Kris:  So, the field and the study of pain science is really absolutely exploding right now. I mean there is research and studies being done all the time which is really encouraging because then it promotes new treatment techniques and treatment options and pain is a very complicated thing quite honestly. But in the December 2019 issue of Physical Therapy and Motion Magazine; there’s an article that states and I will quote this, “We have created a society that is dependent on taking medications to manage issues rather than working to cure them. It would be far more productive if our medical professionals encouraged patients to learn more about their body through physical therapy to prevent a reoccurrence of their neck or back pain rather than reinforcing the notion that every time you hurt yourself all you need is a couple of pills.”

And it’s funny because in that same magazine, there was another small article with a study from the American Physical Therapy Association that they cosponsored that revealed a pattern among people seeking attention for low back pain. When their initial visit was with a therapist, a chiropractor or acupuncturist; it decreased their odds of early opioid use by 85 to 91% and lowered long term use by 73 to 78%. Which again, are huge numbers. So, all the studies really confirm that physical therapy has a really crucial role in the area of pain management.

Host:  So, can you talk to us a little bit about what a typical physical therapy appointment looks like and maybe some of the different methods that you use?

Kris:  So, when somebody comes in for an evaluation, I mean we as therapists, are really fortunate and lucky that we’re granted the opportunity to spend a great deal of time with patients. So, the history for most people and I know for myself, I feel is the most important part of the examination. So, sometimes I can spend up to 30 minutes or even more than that with a patient asking the right types of questions, delving into their history, their habits, anything that might be contributing factors. So, there’s not a lot of other disciplines out there that get to spend that much time with the people. When somebody goes to their primary doctor, they might be in and out the door in ten minutes and the doctor just kind of writes them a prescription and sends them on their way.

We, as therapists, I tell people it’s kind of like trying to figure out a puzzle. The more confusing sometimes more interesting, the more intricate, the more excited I kind of get as a therapist to try and figure out what’s the root of somebody’s problem.

Host:  Yeah, I totally hear what you are saying because when I go to see a doctor, it only feels like they have a couple of minutes for me and they prescribe me a pill that I have to take and if that doesn’t work, I have to think okay well I guess I’m on my own. But one of the benefits that you said is you see a physical therapist over time. So, I’m curious as to what is the average time that a person goes to see a physical therapist?

Kris:  It kind of varies because when I talked about types of pain, one of the other types of pain we see quite often is people with chronic pain. So, this might be someone when you say how long have you had this problem or this pain; many times it’s more than a year, five years, sometimes even ten or twenty years and they’ve never been referred to physical therapy.

Host:  What I’m really hearing from you is that if you have chronic pain, the right thing to do might be actually to go see a physical therapist first because they are going to assess what the issue is and really get to the root cause of it rather than going to a doctor who might just give you a pain medication to address the symptom. Is that correct?

Kris:  Right, oh absolutely. It’s unfortunate when I talk to a lot of people that have had chronic pain. When I ask them if they have ever had therapy or treatment; a lot of them say no. which I’m sure the look on my face kind of says what I’m thinking, and I find it very incredulous that nobody has thought of it but the thing with physical therapy is I think we are underestimated. I don’t think patients as well as doctors know the extent of the training and education we have, the ongoing courses we have, all the modalities and treatment techniques that we have available depending on what their issues might be.

So, we’re not really thought of quite often when somebody goes to their primary doctor for that pain that they start having in their shoulder or their back and this is where I would like to see physical therapy chosen as that initial intervention for people. So, I think education with doctors, with the public, is a big piece of it and it’s something that I feel very passionate about that I would like to start to get more into. Advocating for our services.

Host:  Yeah, I think so much of it is and I can also speak from my own personal experience; oftentimes when you go to the doctor and they give you that pill; it’s that instant pain relief where physical therapists you are like oh my gosh this is going to take so much time and so much money. Do I really want to go through with this? So, when you are talking to people like myself that think that way; what might you say to convince them?

Kris:  You know there are people that actually do look for that quick fix and want just that pill and kind of be on their way. But when someone goes to their doctor because of a pain or a problem that they’re having and patients tend to not go as soon as they used to because it’s time, it’s copay or a big issue for patients. So, if they go to their doctor, they usually have been having their problem for a little bit of time. So, when they are written that prescription, and they take it, so it does help with the pain but it kind of masks it. So, it doesn’t treat the cause of the pain. So, if you have pain in your back and the root cause is maybe you have a disc issue or maybe you have a joint stiffness or maybe you have spasm; it might make that pain feel better, it might make you feel better and your pain more manageable; but it doesn’t go to treat the root of the cause.

So, most likely, the pain is going to continue to come back. So, unless you do get to the root of what’s causing your problem and this can be with any orthopedic problem from head to toe in your body; unless you treat that root cause, it kind of sets you up for a dependence on pain medications as a way of treating it. So, the unfortunate thing I will tell you in physical therapy is education with a specificity for the correct exercises for patients is really huge but compliance with exercises at home for patients is mostly very poor in many cases, unfortunately. So, we have to get somebody to buy into physical therapy. They don’t know what we do.

Doctors tell patients I want you to go to therapy and get some exercise. But exercise is just one little piece, one small piece of what we do. And I think educating the public again as well as doctors and the host of modalities and options that we have is huge. Like the new things on the market that have been around more recently are like cupping, tri-needling, a technique called Graston or instrument assisted soft tissue massage. For people with really bad pain, there’s this graded imagery and mirror therapy. So, we are always going to classes. We are always going to courses. We are always trying to learn how to treat people more effectively.

Host:  Yeah, that’s fantastic to hear. I’m curious as to what you treat most often as a physical therapist. Like who comes to see you the most?

Kris:  So, I’ve been in outpatient orthopedics for over 30 years. so, I can say without doubt that the most common problem that we see, or pain is low back pain. So, there are so many different things that can be contributing factors for back pain with somebody. Disc issues are for sure one of the most common and this is a case where education with people is just really crucial to manage their symptoms as well as to prevent reoccurrence. So, I kind of tell patients with back pain when I work with them that it’s the nature of the beast. Like if you have had back pain one time; you are more than likely going to have it again and sometimes every time you have it, it gets a little bit worse and worse. In those cases, self-management and awareness are huge and extremely important.

And again, we try out best to get that point across to the patient that heh, it’s not just you need to do these exercises until this pain goes away or you feel better; this is something you have to buy into long term and doing for sometimes the rest of your life. But it’s funny because one study that I read said that only 8-10% of patients who should get therapy as a first step in treating back pain actually do which is really pretty sad. Some doctors are big advocates for therapy and others just are not and I’m really not sure why. But again, it’s something I found a trend with in all the years that I have been working as a therapist.

And it’s funny because another study with back pain they looked at patients aged 18 to 84 over a one year period and their primary diagnosis was of low back pain. And they found that people who saw therapy first or went to physical therapy first; had a lower probability, that’s 89.4% which is a huge number of having an opioid or needing an opioid prescription.

Host:  Wow. That’s a really big number.

Kris:  It is a big number.

Host:  So, I’m curious for the people that are listening to this that have already become dependent on pain killers; what do you within physical therapy to both prevent a relapse and just to convince them that physical therapy is the right way to go?

Kris:  I think the most important thing is they have to trust you day one. You have to be confident in what you are saying, in what you are telling them and what you are teaching them and what you are educating them. They have to 100% buy in, otherwise they won’t return. Copayments are very high sometimes we have people with copayments of 50 or 60 dollars. So, for them to come once or twice a week, it’s really a big bite out of their pocketbook. So, I consider that one of the most important things on day one is spending the time with them to get them to understand my explanation for what I found with the evaluation and what our treatment plan is going to be and that them buying in, they have a part in their rehab as well is very important.

Host:  So, just in wrapping up here, I’m sure that people that are listening to this, they hear you in terms of the benefits that physical therapy has, but maybe they are a little bit resistant to the idea either because of the copayments, the frequency of visits. What might you say to them to potentially turn them around?

Kris:  We can work with anybody and any circumstances. I mean we are lucky at Harrington if someone has an issue with copays, there is a department that they can – there’s a number that they can call in a department that they can help out and kind of make some arrangements regarding copayments. The other thing too, is if somebody comes in and says I can only come once a week or I can come every other week; I mean we work with whatever patients can do. And we’re very lucky that we can schedule a longer treatment time for them. Big thing is, because a lot of doctors may not be advocates, I really encourage patients to be the ones if they are having a problem, when they go to their doctor ask for a referral to physical therapy themselves. I mean the sooner that they get in, and the sooner that we get to see them; the better.

Host:  Well that’s wonderful advice and it’s definitely changed my perspective after this conversation with you so Kristine, truly appreciate your time. That’s Kristine Fontaine, a Physical Therapist at Harrington Hospital. Thanks for checking out this episode of Healthy Takeout. Head to to get connected with Kristine Fontaine or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.